Cho Sung-Shin, Joh Jin Hyun, Ahn Hyung-Joon, Park Ho-Chul
Department of Surgery, Kyung Hee University School of Medicine, Seoul 134-727, Republic of Korea.
Exp Ther Med. 2016 Oct;12(4):2639-2643. doi: 10.3892/etm.2016.3637. Epub 2016 Aug 31.
Stroke imposes a substantial clinical and socioeconomic burden. Carotid endarterectomy (CEA) or carotid artery stenting (CAS) are proven procedures in stroke prevention for the lesions of extracranial carotid disease. Although several studies have addressed national trends regarding carotid revascularization in Western countries, limited data is available with respect to the Korean population. The aim of the present study was to identify the national trend in carotid revascularization in Korea over the previous decade. A serial, cross-sectional study was conducted with the use of time trends to analyze patients undergoing carotid revascularization using CEA and CAS between 2004 and 2013. Health Insurance Review and Assessment Service data was used. The present study endeavored to analyze trends in the number of CEA and CAS procedures for the treatment of extracranial carotid disease in Medicare beneficiaries. A linear-by-linear association was performed to determine the changes of carotid revascularization for the aforementioned period. A total of 23,142 patients received carotid revascularization between 2004 and 2013. CEA was performed in 4,012 and CAS in 19,130 patients. The rate of total carotid revascularization per 1,000,000 Medicare beneficiaries substantially increased during the study period from 22 procedures in 2004 to 57 in 2013 (risk ratio (RR), 2.59; 95% confidence interval (CI), 1.58-4.24; P=0.001). CAS increased from 18 procedures in 2004, to 45 in 2013 (RR, 2.50; 95% CI; 1.45-4.32; P=0.001). In addition, the number of CEA procedures performed per 1,000,000 Medicare beneficiaries increased from four procedures in 2004, to 11 in 2013 (RR, 2.75; 95% CI, 0.88-8.64; P=0.08). In conclusion, total carotid revascularization increased by 255% during the previous 10 years in Korea. This increase predominantly resulted from the 249% increase of CAS. The number and population-based rates of carotid revascularization remained low, as compared with Western countries.
中风带来了巨大的临床和社会经济负担。颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）是已被证实的用于预防颅外颈动脉疾病所致中风的手术。尽管已有多项研究探讨了西方国家颈动脉血运重建的全国趋势，但关于韩国人群的数据有限。本研究的目的是确定韩国过去十年间颈动脉血运重建的全国趋势。我们进行了一项连续性横断面研究，利用时间趋势分析2004年至2013年间接受CEA和CAS颈动脉血运重建的患者。使用了健康保险审查和评估服务的数据。本研究致力于分析医疗保险受益人中用于治疗颅外颈动脉疾病的CEA和CAS手术数量的趋势。进行线性 - 线性关联分析以确定上述期间颈动脉血运重建的变化。2004年至2013年间共有23,142例患者接受了颈动脉血运重建。4,012例患者接受了CEA，19,130例患者接受了CAS。在研究期间，每100万医疗保险受益人中颈动脉血运重建的总比率大幅增加，从2004年的22例增加到2013年的57例（风险比（RR）为2.59；95%置信区间（CI）为1.58 - 4.24；P = 0.001）。CAS从2004年的18例增加到2013年的45例（RR为2.50；95% CI为1.45 - 4.32；P = 0.001）。此外，每100万医疗保险受益人中进行的CEA手术数量从2004年的4例增加到2013年的11例（RR为2.75；95% CI为0.88 - 8.64；P = 0.08）。总之，在过去十年中，韩国颈动脉血运重建总数增加了255%。这种增加主要是由于CAS增加了249%。与西方国家相比，颈动脉血运重建的数量和基于人群的比率仍然较低。
